Healthcare Provider Details

I. General information

NPI: 1487279659
Provider Name (Legal Business Name): CHRISTI LYN BADER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 W ELDER ST SUITE 209
BOISE ID
83705
US

IV. Provider business mailing address

68 HARRISON AVE SUITE 600
BOSTON MA
02111
US

V. Phone/Fax

Practice location:
  • Phone: 657-500-0634
  • Fax:
Mailing address:
  • Phone: 657-500-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1662585
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11021274
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995655-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: